Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T., is a board-certified cardiologist, certified bioenergetic psychotherapist, and certified nutrition and anti-aging specialist. He has lectured and facilitated workshops worldwide and has authored several publications and medical periodicals. He has been a featured guest on many national radio and television shows including CNN, MSNBC, Fox on Health, the Dr. Oz, The Doctors, and 700 Club shows, and The Today Show.

Is It Safe to Mix Fish Oil and Blood Thinners?

I make no bones about how much I love fish oil. I’ve recommended it for more than 20 years and have seen some great results in people who take it—including improvements in atrial fibrillation, blood pressure, heart rate variability, a racing heart and other arrhythmias. The omega-3 essential fatty acids that fish oil contains help neutralize the effects of Lp(a), reduce arterial inflammation, improve endothelial function, and promote healthier circulation and clotting.

I’ve even been known to say that taking fish oil is “like wrapping the heart in a warm blanket.” Who wouldn’t want that?

But as perfect as fish oil may seem, I’m often asked by people who take prescription blood thinners if it’s safe to combine fish oil with their Plavix or warfarin (Coumadin). They worry that the blood thinning effects of fish oil will interact with their medications and put them at risk for excessive bleeding.

Increased Fish Oil Use Raises Drug Interaction Fears

In 2005–2006, researchers monitored a nationally representative sample of more than 2,000 adults, ages 57–85, to learn how many medications each person, on average, was taking and for what drug interactions the study group was most at risk. (“Medications” were defined as prescription drugs, OTC drugs, and supplements.) In 2010–2011, the researchers repeated the survey with a similar demographic group and compared the findings.

Not surprisingly, they discovered that more people are taking more prescription drugs, with statistically significant increases in the use of statins and antiplatelet blood thinners. They also found an increase in the use of supplements, with a statistically significant uptick in the number of people taking fish oil.

The percentage of people at risk for potential major drug interactions was found to have almost doubled, from 8.4 to 15.1—a jump the research team strongly implied could be due to the increased use of fish oil and blood thinners.

Fish Oil and Blood Thinner Interaction Realities

I don’t disagree that fish oil and blood thinners—particularly antiplatelet blood thinners—need to be handled with care. The omega-3 fatty acids in fish oil help make blood platelets less likely to clot; antiplatelet blood thinners do the same thing. Too much of both can increase the risk for excessive bleeding from minor, everyday cuts or from the gastrointestinal side effects of drugs like aspirin or NSAIDs, as well as bruising or injuries that may occur as the result of a fall. Blood that is too thin also raises the risk of hemorrhagic stroke, especially in patients over age 85.

Still, the study did not provide any evidence that people taking both fish oil and blood thinners are in imminent danger. In fact, there are no studies that I know of to support such a claim.

There are, however, many studies that demonstrate the cardiovascular benefits of fish oil and omega-3 essential fatty acids on blood pressure, arrhythmias, triglycerides, and arterial health.

How to Safely Take Fish Oil and Blood Thinners

So back to our original question: Is it safe to mix fish oil and blood thinning drugs?

I believe it is, as long as the dosages of all drugs (including fish oil) are managed properly.

Modest amounts of fish oil, say 1–2 grams daily, generally can be tolerated even if you are taking prescription blood thinners. However, doing this is not without some risk—so it’s absolutely essential that you be up front with your doctor about the fish oil products you’re taking and how much, to avoid unsafe drug interactions. I cannot emphasize this enough. You must work collaboratively with your physician and regularly monitor the clotting agents in your blood. (Prepare for the conversation by reading how to talk to your doctor about supplements.) It’s also crucial that you don’t replace a blood thinning therapy that your doctor has prescribed with fish oil, unless that doctor says it’s okay.

Remember, too – blood thinners aren’t limited to prescription medications. Aspirin is also an antiplatelet therapy. If your doctor has prescribed an aspirin regimen for you, you also must tell him or her about your fish oil use. Other supplements can have blood thinning effects, too. These include garlic, nattokinase, vitamin E, ginger, and bromelain.

If you find that fish oil causes your blood to thin too much, use it as an opportunity to ask about reducing the dosage of your prescription blood thinner. But don’t give up your fish oil, unless you absolutely have to. The benefits are simply too great to forego.

Leave a Reply

Mary

on September 7, 2016 at 2:30 pm

Is Krill Oil the same and has the same effects as the fish oil?

Sheri Margulies-Semel

on September 7, 2016 at 3:28 pm

I have been taking fish oil (YOUR Omega 3 caps) for years now. I no longer need Coumadin for my afib because that seems to have been ‘cured’ by my third ablation 6 years ago…knock on anything that even RESEMBLES wood! However, I do have very, very serious back problems and won’t take prescription meds like Vioxx or whatever is out there now. I was taking Natto (your Natto) for a very long time, but I found that substituting one Excedrin a day for one of the two 650 mg. acetaminophen tabs I was taking along with 100 mgs. of Tramadol a day, is more effective than the two acetaminophens. I also take lots of your Pro Med formula, but of course, I’m still in pain and just try to live with it. I see my chiropractor every 2weeks, stretch and do Qi Gong daily, and at 70, that’s all I feel I can do. My question regards the aspirin in the Excedrin. Aside from seeming to cause me some gastric distress (when it happens I lay off the pills for a few days), do you see any reason to worry about the combination of the Fish Oil with the Excedrin? I don’t take the Natto now for this reason although I think it was a healthy thing to take.

Elizabeth

on September 8, 2016 at 5:01 pm

How do you feel about coconut oil for frying eggs, etc?

Albert Padgett

on September 8, 2016 at 5:02 pm

I have been taking your Omega Q Plus for years have been very pleased with results. I am on warfarin taking 7& one half mg a day, would like to add your curcuwin turmeric extract(rhizome) , can this be added without any adverse effects, I have a-fib as well.

HeartMD Editor

on September 8, 2016 at 5:24 pm

Hi Elizabeth, Dr. Sinatra likes it; like butter, coconut oil has a higher smoke point than vegetable oils, which means it’s less prone to oxidation, and thus a healthier choice to fry with.

Ross Bayne

on September 9, 2016 at 2:08 am

Hi Sheri – This is a purely anecdotal and personal comment, and I offer it only as such, and I know nothing of the detail of your back condition [although from what you say, you are managing with some duress, and I have every sympathy]. Having said that, there are a number of anti-inflammatory agents around with lesser side effects that you may like to consider, I am sure under advice. Albert P [above] mentions Turmeric [Curcumin] which I have been taking recently, and find effective: I also use a gel and capsules based on an unlikely sounding substance that is the basis of Pernaton [trade mark] – this is a New Zealand green lipped mussel extract, processed in Switzerland, that has [I have found] a wide variety of uses, and best priced with Amazon – the primary caveat is being wary if you have a fish/ marine allergy/ intolerance/ sensitivity. I have found it excellent for anything from headaches to the lower back aches I still encounter from Pilates and Yoga, and also I would add the huge benefits over time! Lastly, as a counter to the gastric irritation you occasionally encounter, I would proffer a local antagonist, Gaviscon, either in tablet or liquid form, that instantly provides relief. How have I encountered these, and what is my position? Well, I am an ICU health care professional in UK, recently retired, but with a long term interest in alternate approaches – 4-5 years ago, an orthopaedic surgeon I consulted stated that I required an urgent total knee replacement, based on my X-ray, and subsequent MRI/ CT scans. I was finding difficulty walking, in a lot of pain and concerned about my prospects! We discussed it, and decided that we would be conservative in action, look to other approaches, which I have done [Steven Sinatra and Jim Healthy’s book on arthritis has been a stalwart text for me] … I will only say – in brief – that matters have hugely improved, and no operation. Be encouraged – my approaches are very critically aware based but take from many sources, always seek ways that work with the body’s own mechanisms and minimise side effects. I am active, walk, SCUBA dive, play with the grandchildren, and I am healthy – and take a range of supplements – I wish you well – Ross

joannehyrkin

on September 9, 2016 at 2:31 pm

i just read your article i must say i follow youe letters all the time and also follow your advice i have afib iwas taking xyltol aand after reading your article on blood thinners i switched to eliquis i take it 2 times a day 5m each time also on beta blocker nalodol one a dayi also take epa.dha 500 ec oils 2 a day also multi vit 400 iu vit e.also it has b12450mcg and thsaes are included in the multi i take 6 a day aalso i eat pineapple which has bromelein are these things i need to be concerned about i will also ask my heart dr but you know much more thank you.

HeartMD Editor

on September 9, 2016 at 2:59 pm

Hi Albert – Dr. Sinatra has had patients in the past who took both tumeric and warfarin, and does not generally have concerns about taking both, but cautions against high doses (over 1 gram of day), as it could cause an interaction. Always monitor use of both with your prescribing physician.

carolyn Farrell

on September 9, 2016 at 7:42 pm

My husband takes Pradaxa 150 mg. 2 times a day. He also takes 81 mg aspirin a day. He has been taking 4 of Dr. Sinatra’s COQ10 plus for many years . He is 80 years young and has had a heart attack, open heart surgery and a Stent. He has a difibrilator pacemaker combo. He has benn cared for by two cardiologist, and they are both aware of all the fish oil, flax seed oil and other supplements that he takes . The only problem with thinning blood is bruising when he bumps himself. Because he takes Pradaxa, there is no need for regular protimes like you have to have with coumadin. HIs physcians do not seem to think that there is any harm with the combination of the two in making his blood too thin.The only precaution is if he is going to have any procedures , in which case he is instructed to be off of all of the items that thin the blood for at least three days before the procedure.

joannehyrkin

on September 10, 2016 at 4:58 pm

i am 83 years old and have afib i am on eliquis based on your articleand i take nalodola beta blocker i do take fish oils 2 a day and a multi whuch has vitamin e and b12 i also eat a bunch of pineapple my heart dsr has not given me any tests to see how my bklood is i will say something to her but should i continue to take these things i do not have hifgh blood pressure or problems of cholesterol i do not even know i am in afib thank you i reads your newsletter faithfully. joannehyrkin

Am 67 and I do take fish oil for quite some time. I was prescribed clopidogrel and 50 gm metoprolol because of interlock arteries After 3 years when I was getting chess pain the private cardiologist added 30mg. Diltiazem and I was o.k.But now the hospital cardiologist says that if I take metoprolol with diltiazem it will block my heart.I am in a dillema .. Please advise me doctor.Thanking you in anticipation.

HeartMD Editor

on September 15, 2016 at 9:44 am

Hi Rajen, Dr. Sinatra gives as much heart-health information as he can to the general public through this site, but cannot give individual medical advice to non-patients (and he no longer sees new patients). This is something you need to discuss with your doctor or another doctor who can give you a second opinion. We’ll try to get more information up at HeartMD about the medications you mentioned, though. Best wishes.

James Donovan

on June 12, 2017 at 11:18 am

Greeting to all, Dr. Sinatra my mom referred me to you, she is 73 yrs. old and living in Fl. I am 56 rs. old in Ct. My issue is having a blood clot in 2014 started from my right calf (leg) and then spreads to both lungs. I didn’t get hit, dont play sports, but do lift weights 4-5 days a week without any physical contact. My Dr. placed me on Zarelto 20 mg for 6 mnths. and then aspirins 81 mg. Well the clot came back 2 yrs. later june, 2016. tHis time it was in my right chest area only. I was placed on Zarelto 20 mg again forever. My concern is , Is there anything (otc) I could take equivalent to Zarelto Rx?

HeartMD Editor

on June 12, 2017 at 4:34 pm

Hi James,

When it comes to blood clots, conventional blood thinners can be lifesavers. Whether or not a natural blood thinner can be substituted is a case by case decision. You would have to make this decision with your doctor. Nattokinase or lumbrokinase could be options. Dr. Sinatra discusses the use of these supplements in the book he co-authored with Dr. James Roberts: “Reverse Heart Disease Now“. Unfortunately, Dr. Sinatra is retired and cannot give medical advice but you can contact Dr. Roberts office. You can find his information and that of other cardiologists Dr. Sinatra recommends on his Top Docs List here.

Karl S.

on June 17, 2017 at 11:24 pm

I am 70 and came up with a blood clot behind the left knee 5/16. Took Eliquis 6 months a second ultra sound and then stopped. The D-Dimer test 6 months later says I may still be at risk. Back on Eliquis 5mg daily. Take 10 mg of a statin and 600 mg of a trigeminal neuralgia controler. Should I also take Omega 369? I also took the blood test for the chances of the clot to return. All negative. I weigh 200 lbs and walk an average of 1 mile per day and normally do 2.25 miles per day as long as nothing else in the schedule slows me down.

HeartMD Editor

on June 29, 2017 at 8:39 am

Hi Karl,

It would be best for you to stick to a low dose of omega 3 fish oils (as it can thin the blood) at about 1 gram per day. Please consult with your doctor about adding this supplement into your program.

Tanya

on August 1, 2017 at 9:41 am

Hi there I went to a naturopath today who said I would benefit from taking 2 fish oil capsules daily. My question is can I take these as I am on Zarelto 20mg to thin my blood due to 2 separate issues with over clotting. I am a fit 45 year old female with no other health issues.

HeartMD Editor

on August 1, 2017 at 11:42 am

Hi Tanya, you should be able to take 2g fish (or squid or krill) a day. Since fish oil is a natural blood thinner, you need to keep your prescribing doctor informed so you can work together and make sure your blood doesn’t become too thin on both the fish oil and Xarelto.

I am 87 yrs old with diabetes 2 and A-Fib. My cardiologist has prescribed 20mg. Xarelto for blood thinning, but the insurance coverage is ridiculous for this particular drug, and i want to use a different less expensive blood thinning drug, or if possible eliminate drugs entirely and use a natural supplement. What do you recomend?

HeartMD Editor

on October 27, 2017 at 12:28 pm

Hi Lowell, When it comes to A-fib, blood thinners are vital in order to protect against dangerous and potentially life-threatening blood clots. In this case, blood thinners can be lifesavers. There are many new variations that can be considered as you can see in this article. We can’t advise on which will work best for you, but you should discuss the many options further with your doctor. If you would like to consult with a doctor like-minded to Dr. Sinatra please look here.

HeartMD Editor

on November 20, 2017 at 11:42 am

Hi Lowell,

The most important thing for you is to be on a blood thinner while you are in a-fib, as the risk of blood clots is very dangerous and they can be life threatening. Natural blood thinners should only be considered when there is no delectation of cardiac chambers. There are numerous options for pharmaceutical blood thinners – perhaps you and your doctor can discuss cheaper options.

Kyoom Abdool

on December 30, 2017 at 5:55 pm

I am a post MI patient with 2 stents insertion a year and a half ago. I am presently on Brilinta 90 mg OD nd Aspirin 81 mg OD. Can I continue to take my Omega 3 fish oil supplement safely? Thank you.

Randy

on April 16, 2018 at 1:00 am

The author of the article wrote: “I’ve recommended it for more than 20 years and have seen some great results in people who take it—including improvements in atrial fibrillation, blood pressure, heart rate variability, a racing heart and other arrhythmias. ” Okay, maybe some of these people the author speaks of did improve, but odds are it was not the fish oil that did it. Chances are that it was OTHER treatments that was responsible for their improvement. Do a google search for a NY Times article titled: “Fish Oil Claims Not Supported by Research”. The article was written in 2015 — only 3 years ago. Here below is an excerpt from the article (in quotations):

“The vast majority of clinical trials involving fish oil have found no evidence that it lowers the risk of heart attack and stroke. From 2005 to 2012, at least two dozen rigorous studies of fish oil were published in leading medical journals, most of which looked at whether fish oil could prevent cardiovascular events in high-risk populations. These were people who had a history of heart disease or strong risk factors for it, like high cholesterol, hypertension or Type 2 diabetes. All but two of these studies found that compared with a placebo, fish oil showed no benefit.”

I would like for the author of this article to read the NY Times article I mentioned above and then please respond here in regards to the fact that the various fish oil claims are NOT supported by research (including the claims you have made). As I said earlier, the people you recommended fish oil to most likely improved their condition due to the superior modern day treatments we not have … and their improvement probably had nothing to do with the fish oil.

HeartMD Editor

on April 16, 2018 at 2:45 pm

Hi Randy, This isn’t the last article like this the New York Times has published, and the research letter the article references is available at https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1787690?alert=article should you want to examine the source for yourself. Unfortunately, in that research letter, there’s no information about dosage or study participants in the referenced data, so we cannot comment on relevant data without going through all those studies. However, the following may be of use to you – the New York Times also recently reported on a 2018 JAMA study stating that there is no scientific support for consumption of fish oil for heart health support. When asked to comment on that, Dr. Sinatra said, “As with many of these studies, the devil is in the details. In this 2 minute video, Dr. Alex Vasquez sums up succinctly why this JAMA study is flawed – I agree with him completely:

1. “Unjustified, selective exclusion of data 2. Inclusion of studies that employed sub-/non- therapeutic doses 3. 9 of the 10 studies used the synthetic “ester” form, instead of the better-digested, natural triglyceride form of omega-3 4. The stated conclusion was at odds with the data presented; and 5. There were numerous pro-pharma conflicts of interest.”https://vimeo.com/257578194/87c7b30e97

Dr. Sinatra sticks with his opinion that fish oil does deliver heart health benefits, and that opinion is based on experience with his own patients, as well as the 20,000 studies showing heart health benefits (that were obviously not a part of either data analysis the New York Times reported on). You can read more about Dr. Sinatra’s thoughts on fish oil (dosages, purity, etc) at https://www.drsinatra.com/fish-oil-benefits-for-heart-disease We hope this helps – Best wishes!

Randy

on April 16, 2018 at 11:15 pm

To HeatMD Editor,

Thank you very much for your response. I will say I am impressed by the info you have given in your response and it does make me think more that maybe fish oil could be helpful after all. I was trusting the NY Times article and that is why I (and probably many others that read the article) assumed that fish oil was not really helping anyone. Now I am not sure what to think. Having said that, I must admit you do make very good arguments for the use of fish oil.

My question now is: what about the interactions of fish oil with OTHER medications (especially blood pressure medicine)? People that take blood thinner medications will very often take other heart medications … especially blood pressure medicines. Is fish oil safe to take with BP medicines and other heart medications?

HeartMD Editor

on April 17, 2018 at 3:11 pm

Hi Randy,

Taking fish oil with most blood pressure medicine is not an issue, but this should be discussed with your doctor before proceeding. Additionally, it’s fine to take many other medications in conjunction with fish oil; however each medication should be considered individually, as well as the totality of all supplements and pharmaceuticals a person is taking, before deciding whether fish oil is a good addition to the program. Such a decision is beyond the scope of what we can provide here.

Pingback:

Fish Oil and Blood Thinners? – Darlene Rose

Randy

on August 16, 2018 at 12:45 am

To HeartMD Editor, Did you hear the most recent news (reported last month) that made big headlines in all the major news outlets… in regards to the most recent major study that basically concluded “fish oil has no major health benefits”? Here is a link to just one of the news outlets that reported the study: https://ind.pn/2zV3wHo So, is this the proof that fish oil is basically “snake oil”?

Randy

on August 20, 2018 at 1:00 am

To HeartMD Editor,

Last month the big headline news in all the major media outlets told about the newest study that said it (the study) proved fish oil does nothing to prevent heart attacks or stoke, and does not provide any heart benefits. I would’ve posted a link to an article about the study, but I don’t know if we are allowed to post links here (I’m sure you can find an article about it by doing a google search.

What to do you think about the newest study debunking fish oil supplements? Does this study prove fish oil is “snake oil”?

HeartMD Editor

on August 20, 2018 at 10:02 am

Hi Randy, Our answer is pretty much the same as above (See April 16th comment), when another meta analysis was published stating no meaningful benefits from fish oil consumption: no, this new study does not prove anything about the efficacy of fish oil supplements. Dr. Sinatra has read way too many studies showing heart health benefits from using fish oil, and seen too many improvements in his own patients, to let meta-analyses like this and the prior study you asked about effectively “debunk” fish oil for him. Without looking at all the data in each of the 79 studies that were reviewed as a part of this most recent meta analysis (at https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003177.pub3/full ), what is a sure sign that this new “study” is not a reliable indicator of fish oil efficacy is the first sentence under Main Results: “We included 79 RCTs (112,059 participants) in this review update and found that 25 were at low summary risk of bias.” What this means is that over 68% of the study data was at high summary risk of bias, and thus unreliable because the studies reviewed were poorly designed – only 31.6% of the studies reviewed were deemed to be reliable. Would you put your faith in that? There are big financial interests in debunking the health benefits of fish oil (shown in so many earlier studies), so there are businesses with lots to gain by having these types of meta-analyses published and widely reported in the media without looking at the little details, only a bottom line skewed by unreliable data. And this is without even looking at whether therapeutic dosages were utilized in any of the studies. We hope this is helpful.

To HeartMD Editor, I apologize for posting the same basic message 2 times in a row. The reason I posted the message a 2nd time is because the first message never did show up on the comment board (however, it finally did show up several days later AFTER I wrote my 2nd message). Thus, I had thought my original message didn’t go through and four days later I decided to post the same basic message again (but this time I left out the article link because I thought maybe the article link was the reason why my first message didn’t go through).

But anyways, thank you for your reply. I do admit you give good reasons why not to rely on all these fish oil studies about their claims that “fish oil has no benefits”. However, I also have to admit it is hard to continue feeling confident in fish oil supplements everytime I see a study claiming fish oil is useless. I know you have given good reasons to keep taking fish oil, but the fact is, it is understandably natural to have our confidence in fish oils supplements eroded each time we see a new headline in all the major media outlets that “fish oil proven to have no benefits”. BUT, having said that, I will continue to take fish oil due to the reasons you have given, along with the fact that I haven’t seen anywhere of fish oil being bad for people (except for the possibility of people with serious blood thinning issues). I figure the potential upside of fish oil is worth the purchase of a bottle of fish oil each month.

Now, if we can only get the media to do a better job of looking at the details of these negative fish oil studies and report the TRUTH of these “studies”. Is it any wonder why we often hear of the phrase “fake news” in regards to the media?

HeartMD Editor

on August 29, 2018 at 1:23 pm

Hi Randy, we get a ton of SPAM comments here at HeartMD, so we manually review and approve each one that comes through, hence the delay (if we are not online at the time a comment comes in). My apologies for this most recent delay, we just saw your comment above now and published it!

George S.

on October 5, 2018 at 4:50 am

Hi I am 70 years young and taking medication for blood pressure cholesterol enlarged prostate and l have af which I take Pradaxa. Will it be safe for me to take fish oil supplement? I wii discuss this with my GP next visit but I would appreciate another opinion as well

Regina M

on November 7, 2018 at 3:53 pm

Can you mix or take flax seed oil capsules with eliquis? My Elderly Mom has SVT She has blood clots in her legs and plaque in her leg veins. Put her on Eliquis. She’s been on Norvasc and Digoxin for her SVT. Other than Vitamin C and Vitamin D and Multi Vitamin and B’s afraid to give her any minerals or vitamins. Vitamin K foods are off the list. Can she take flaxseed oil capsules. Afraid to let her drink any teas, other than…camomile. She has severe osteoporosis. Can she mix magnesium and calcium with blood thinners? We’re New to this nightmare of blood thinners read on this forum you can eat pineapple with blood thinners?

Nancy Wynne

on January 31, 2019 at 3:24 pm

Dr. S, you are the best saving many lives. I like your products and continue to use them.